This increase in the blood flow to the working muscles provides necessary delivery of oxygen and nutrients to the working tissues. The normal response to exercise is an increase in blood flow. It is this tough fascia that fails to expand with muscle swelling that contributes to the development of compartment syndrome. All four muscle compartments are fully encased by tough connective tissue (“fascia”) that is relatively inelastic and does not expand much.
#Symptoms of compartment syndrome in lower leg skin
Finally, the lateral compartment contains the muscle that rotate the foot outward (“evertors”) and the superficial peroneal nerve which is responsible for supplying sensation to the skin over the top of the foot. The deep posterior compartment contains the toe flexors, the posterior tibial artery/vein and the tibial nerve which supplies the skin on the bottom of the foot. The superficial posterior compartment consists of the gastrocnemius and soleus muscles flex the foot (“tip toes” position), and the sural nerve which provides sensation to the skin over the lateral aspect of the foot. The anterior compartment contains the muscle bellies that extend the toes and the foot along with the anterior tibial artery and the deep peroneal nerve supplying sensation to the skin between the first and second toes. In addition to muscle bellies, each compartment also contains one major nerve and contain major blood vessels. The lower leg is between the knee and the ankle has 4 muscular compartments identified based on their location: anterior, lateral, deep posterior, and superficial posterior compartment. The most common location for the CECS is the lower leg. The areas most commonly affected by the CECS are lower leg, forearm, and thigh muscles.Īnatomy of Exertional Compartment Syndrome The pain is always associated with exercise and tends to resolve with the cessation of activity without any persistent clinical sequalae but returning with the next bout of exercise. The muscular compartment becomes tight and painful preventing further athletic participation. CECS is more common in running athletes and is characterized by exercise-induced increases in compartment soft tissue pressures that are reproducible with activity and resolve with rest. ACS has been described in almost all fascia-enclosed compartments of the body including leg, thigh, hand, forearm, foot, etc.Ĭontrary to the Acute Compartment Syndrome, Chronic Exertional Compartment Syndrome (CECS) is not a medical emergency. Patients with ACS present with severe pain worsened by a passive stretch, muscle compartment tightness, paresthesia (sensory deficit/tingling), pallor (pale/pink skin) and absence or decrease in distal pulses.
ACS requires urgent surgical attention to avoid permanent damage to the involved muscles. It usually follows fractures, soft tissue crush injuries, blood vessel injuries or other traumatic decrease in blood flow. Acute Compartment Syndrome (ACS) is an orthopedic emergency often associated with large increase in tissue pressure. This condition can be either acute or chronic. By Asheesh Bedi, MD and Adnan Cutuk, MD What is Chronic Exertional Compartment Syndrome?Ĭompartment syndrome is a condition defined as increased pressure within the muscle and its surrounding tissue envelope (“fascia”) resulting in a reduced blood flow, pain, and possible muscle injury within the compartment.
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